This document discusses proper care of intravenous catheters and prevention of hospital-acquired infections. It emphasizes that catheter insertion requires the same sterile precautions as surgery. The skin should be disinfected with chlorhexidine for 30 seconds before insertion to reduce infection risk. Intravenous lines should be replaced every 3-5 days and giving sets changed every 72 hours to prevent bacteria from contaminating the catheter and entering the bloodstream. Following basic hygiene procedures like hand washing and disinfecting medical equipment can significantly reduce infection rates.

1. Care of the Intravenous Catheters
What the House Surgeons and Residents Should Know?
Dr.T.V.Rao MD
The Junior Doctors, House surgeons and Residents progress with time and are happy to
learn basic skills to support the life, one of the important procedure is inserting a
Intravenous Catheter (IV catheter) when a patient is brought to the Causality, Never
forget we are a in hurry in many cases of accidents and start doing things without
minimal health care precaution taking into consideration the most important matter the
INFECTION hunts the patients after they are shifted to wards, the matters to do end with
the patients, the infection acquired with unhygienic insertion of catheters will be spread to
many others in the form of Hospital acquired infection, among the patients around him. If
I am frank the Infection in a helpless patient starts when he just enter the hospital, Never
underestimate the 1st event in the increase of Hospital acquired infections, Intravenous
catheters are put in most of the patients in our Hospitals, it has become a formality to put
catheter without any indication as many wish to run the life line without much though.
However, in critically ill patients, intravenous lines are responsible for at least one quarter
of all nosocomial blood stream infections, with a 25% reported mortality. Most causative
organisms originate from the skin: staphylococci cause two thirds of the infections, with S
aureus accounting for 5–15% of these. The insertion of an intravenous needle or cannula
results in a break in the body's natural defenses. Organisms can enter the circulation
from contaminated fluid or a giving set, or can grow along the outer surface of the
cannula. The junior residents and house surgeons should realize putting catheter is as
good as Incision we do in case of surgeries Prevention of complications requires careful
insertion practice and optimal catheter care. Inserting a peripheral catheter demands the
same precautions as for any surgical procedure. The hands should be disinfected with
alcohol and gloves should be worn. The skin of the insertion site must be thoroughly
disinfected with alcoholic chlorhexidine or 70% isopropyl alcohol for at least 30 seconds
and allowed to dry before inserting the cannula. The insertion site should not be touched
after disinfection. When 2% chlorhexidine, 10% povidone-iodine, and 70% alcohol were
compared as skin disinfectants, the rate of catheter-associated bacteremia was almost
fourfold lower in the patients who received chlorhexidine than in the two other groups.
We are not here for academic comparisons our Hospitals should choose Chlorhexidine in
routine practice, Next comes the Routine replacement of the intravenous line every three
to five days is common practice in the USA but not in Europe. Guidelines developed by
the Centers for Disease Control and Prevention recommend that peripheral intravenous
catheters be changed every three days. However, routine replacement of central venous
catheters was no longer supported in their latest update. A recent Swiss study was
unable to show an increased risk of catheter related complications—phlebitis, infections,
and mechanical complications—during prolonged peripheral catheterization. Peripheral
catheters can be safely maintained with adequate monitoring for up to 144 hours (six
days) in critically ill children too. Containers of intravenous fluids are checked for turbidity
or possible contamination never forget it still can happen with all quality controls, but the
giving set does not need to be replaced more often than every 72 hours.37 “Flagging”
each set with a sticker displaying the time it had to be replaced resulted in a significant
reduction in the incidence of Klebsiella in a busy neonatal unit There is no difference in
the incidence of septicemia in children who have in-line bacterial filters fitted compared
with those who do not., Never forget to act with wisdom and scientific preparedness
Practical methods for preventing nosocomial infection
What's in Hand washing: as often as possible use of alcoholic hand spray removing
jewelry before washing Stethoscope: cleaning with an alcohol swab at least daily
Gloves: supplement rather than replace hand washing Intravenous catheter: thorough
disinfection of skin before insertion changing administration sets every 72 hours
What's outdated scientifically Hand washing: using a brush Mask: routine use in theater
during wound dressing Gowning: routine use in neonatal units White coats: enforced use
in clinical unit’s Intravenous catheter: routine removal of peripheral catheters after 72
hours of use of impermeable, transparent dressings in-line bacterial filters. (These

2. suggestions are supported with scientific studies, it can be discussed with Institutional
policies)
I wish all the Junior doctors to make progress with current ideas and peer reviewed
studies, NEVER FORGET INFECTION CAN BE PREVENTED BUT MANGED WITH
LOTS OF ANTIBIOTICS AND ECONOMIC LOSES AND INCREASES THE MORBIDITY
AND MORTALITY IN OUR LOVED HOSPITALS.
Ref The health professional's role in preventing nosocomial infections H Saloojee, A
Steenhoff
Dr.T.V.Rao MD Professor of Microbiology Travancore Medical College, Kollam Kerala
(Part of series to empower our junior doctors to change culture of working )